Carlos Grilo, PhD, Discusses Binge Eating Disorder at CASAColumbia’s First Addiction Speaker Series
In the inaugural session of our Addiction Speaker Series, Carlos Grilo, PhD, a senior scientist at CASAColumbia and a professor in Yale School of Medicine’s Psychiatry department, discussed binge eating disorder (BED), a new formal diagnosis in the DSM-5. The Addiction Speaker Series is a new initiative held each month at CASAColumbia in which leading experts in the addiction and substance abuse field present some of their latest findings.
Although BED is an eating disorder, not an addictive disorder, a central aspect of both types of disorders, according to Dr. Grilo, is a loss of control over intake or behavior. “In the case of BED, there’s a loss of control during eating episodes and food intake,” Dr. Grilo said.
BED affects 2.6 percent of the population, making it more prevalent than the two other formal eating disorders - bulimia nervosa and anorexia nervosa - combined. BED also cuts across all races and ethnicities, and it affects both men and women. And while BED is strongly associated with obesity, the two conditions are distinct.
BED is characterized by recurrent episodes of binge eating, in which the person eats unusually large amounts of food while experiencing a complete loss of control. People describe the loss of control in various ways, including for example, eating much more rapidly than usual, not being able to stop eating despite not being hungry, and eating to the point of physical discomfort or when food runs out.
“The binge eating often occurs alone because of embarrassment or shame and is typically followed by strong feelings of guilt, disgust, and depression,” explained Dr. Grilo. “This tends to be a secretive and highly embarrassing behavior for most persons who end up suffering in silence.”
According to Dr. Grilo, people affected by BED are typically greatly concerned about their body weight and shape and this negatively impacts how they feel or evaluate themselves. People with BED often have a long history of failed diets and inappropriate or overly restrictive dieting is thought to be of several possible precursors to BED.
“People with BED try to control their weight and their eating patterns in order to influence their weight and shape,” said Dr. Grilo. “And when they are successful, they feel better about themselves. When they are not successful, they feel lousy about themselves and they either feel powerless to control their eating or they become more extreme in how they try to control their eating and weight. And when you get into more extreme behaviors, one inevitable result is the loss of control.”
“Binge eating often occurs while experiencing negative emotions,” said Dr. Grilo. “Many persons with BED have difficulty managing certain uncomfortable feelings such as anxiety, sadness, or boredom, and describe often binge eating in response to such feelings especially if they’re along or during periods of stress.”
There appear to be some similarities in people with BED to those with addictive disorders, where negative emotions often play a major role in the misuse of substances or in the resumption of substance use after a period of abstinence, which is known as relapse. In addition, about a quarter of BED sufferers have some form of substance use disorder at some point during their lifetime.
Although some elements of BED overlap with those of the relatively new construct of “food addiction,” the two are not the same. Through CASAColumbia’s new collaboration with Yale School of Medicine, we will be studying the areas of overlap among food addiction, substance addiction, and problems with eating and weight.
Dr. Grilo explained that there are treatment options for people suffering from BED:
- Certain forms of therapy have been shown to have effective results in alleviating the symptoms of BED. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), which can be delivered short-term (e.g., roughly 16 weeks), generally produce complete remission or abstinence from binge eating in 50 percent to percent of patients with BED along with substantial improvements in body image and psychosocial functioning. Long-term studies have found that the positive outcomes achieved with these psychotherapies can be maintained for up to four years after completing these treatments
- Behavioral weight loss treatment, which is a structured lifestyle approach incorporating behavioral therapy, has also been shown to be a viable treatment for BED, and it has the added benefit of producing modest weight loss
- Several medications, including U.S. Food and Drug Administration-approved Vyvanse, have been found to reduce binge eating over the short-term, but almost nothing is known about their longer-term effects. The very few available studies with BED point to the superiority of CBT over pharmacotherapy over the longer-term
While much headway has been made in addressing BED, it has only recently been classified as a formal disorder, having been added to the 5th edition of the DSM just two years ago. Dr. Grilo explained that more research on BED’s pathology, causes and treatment options is still needed. The inclusion of BED in the DSM-5 may facilitate greater recognition and identification of this disorder by health care professionals.
Read more about BED in Dr. Grilo's recent publication in the Psychiatric Times.
Carlos Grilo, PhD
Carlos Grilo is a Senior Scientist at CASAColumbia